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ATTENDANCE AND CONFLICT OF INTEREST SHEET

BOARD/COMMITTEE NAME: ____________________________________________ DATE OF THE MEETING: ____________________________

Failure to sign this form will result in the member being counted as absent (unexcused absence). Any vote cast by a member who did not sign will not be counted.

By signing below, members indicate they were in attendance and certify their conflict of interest*, if applicable, related to any agenda item. They agree not to participate

in a discussion, deliberation, or vote on an agenda item for which they have a conflict of interest.

|BOARD MEMBER |SIGNATURE VERIFYING PRESENCE |ARE YOU ABSTAINING OR RECUSING ON ANY |IF YES, IDENTIFY THE AGENDA ITEM NUMBER BELOW. |IF RECUSING, HAVE YOU SUBMITTED AN AFFIDAVIT WITH |

| | |AGENDA ITEMS? | |THE OFFICE OF THE CITY CLERK: |

|DISTRICT 1: | |Yes | |Yes |

|John Doe | |No | |No |

|DISTRICT 2: | |Yes | |Yes |

|Jane Smith | |No | |No |

|DISTRICT 3: | |Yes | |Yes |

| | |No | |No |

|DISTRICT 4: | |Yes | |Yes |

| | |No | |No |

|DISTRICT 5: | |Yes | |Yes |

| | |No | |No |

|DISTRICT 6: | |Yes | |Yes |

| | |No | |No |

|DISTRICT 7: | |Yes | |Yes |

| | |No | |No |

|DISTRICT 8: | |Yes | |Yes |

| | |No | |No |

|DISTRICT 9: | |Yes | |Yes |

| | |No | |No |

|DISTRICT 10: | |Yes | |Yes |

| | |No | |No |

|MAYOR’S APPT: | |Yes | |Yes |

| | |No | |No |

*A board member has a conflict of interest if City Code Chapter 2-7 or Local Government Code Chapter 171 prohibits the board member from taking action on a vote or decision before the board. Please see the reverse side for more information.

|City Recusal Requirements |State Recusal Requirements |City Abstaining Requirements |

|For ALL Boards |For Sovereign Boards |For ALL Boards |

|The City Code requires you to recuse yourself when you have a |The state law applies in addition to the city’s recusal requirements; |The laws and regulations cannot cover every situation that could arise nor|

|“substantial interest” that would be affected by a vote of the board on |therefore, sovereign board members should be familiar with both the city |think of every relationship or emotional tie someone might have to an |

|which you serve. |and state requirements. |issue. |

| | | |

| |You have a substantial interest in real property if you own an interest in| |

|You have a substantial interest in real property if your interest has a |real estate with a fair market value of $2,500 or more. |To help you determine if you have a conflict of interest, when a matter |

|market value of $5,000 or more. | |appears on your board’s agenda, ask yourself: |

| |Under state law, you have a substantial interest in a business entity if: |Do I stand to lose or gain anything because of my decision? |

|You have a substantial interest in a business entity if: |You own 10% or more of the voting stock or shares of the entity |Do I have a close personal or financial relationship with an interested |

|You own 5% or more of the voting stock, shares or equity, or |You own 10% or more or $15,000 or more of the fair market value of the |party that isn’t covered by city or state recusal requirements? |

|Ownership of $5,000 or more of the equity or market value of an entity, |entity. |Have I received a gift or hospitality from anyone who stands to gain or |

|or |You received funds from the business entity that exceed 10% of your gross |lose from this decision? |

|Receipt of funds from a person or entity during the previous 12 months or|income for the previous year. |Will this affect my future employment opportunities? |

|during the previous calendar year equaling or exceeding any of the |State law considers your interests to be the same as someone related to |How would I feel if I saw a story about my connection with this issue on |

|following: |you in the first degree by blood or marriage. The City Code extends this |the news or read about it in the paper? |

|$5,000 in salary, bonuses, boards or professional fees, or |group of relatives to the second degree. Relatives in the second degree |Would I be embarrassed if people found out about my personal connection to|

|$20,000 in payment for goods, products or nonprofessional services, or |include you and your spouse’s siblings, parents, grandparents, children, |this issue? |

|10% of the person’s gross income during that period, whichever is less. |grandchildren, and the spouses of these relatives. If any one of these | |

|You serve as a corporate officer or member of the board of directors or |relatives has a substantial interest, you are considered to have that same|If you feel that you cannot cast a well-informed vote based upon the |

|other governing board of an entity |interest. |information you have in your possession, if you can’t separate your |

|You have a substantial interest if your spouse has a substantial | |personal feelings from a decision, or you think the public would think |

|interest. | |your relationship to a particular issue is suspect–abstain. |

| | |Use your best judgment. |

|Recusing yourself under City Code: |Recusing yourself under State Law: |Abstaining recommendations: |

| | | |

|You make a public disclosure revealing the nature and the extent of your |You must publicly disclose the nature and extent of the interest by filing|You must sign the Conflict of Interest/Attendance Sheet, indicating the |

|substantial interest. |an affidavit with the City Clerk before the vote. |item on which you will abstain, and document your abstention; |

|You must make sure your disclosure is recorded in the board’s official |You must NOT vote. |You may or may not choose to take part in the discussions leading up to |

|records. |You must NOT take part in the discussions leading up to the vote. |the vote; |

|You must NOT participate in the discussion. | |Publicly disclose your abstention; |

|You must NOT vote |If you do not properly recuse yourself under the state law, you could be |Refrain from voting. |

| |subject to prosecution for a Class A misdemeanor. This offense is | |

|Leaving the dais is a good way to emphasize that you are refraining from |prosecuted by the County or District Attorney, and it is punishable by a | |

|participating in the discussion and the vote. |fine of up to $4,000, a year in jail, or both. | |

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